Get Pa Annual Physical Examination Form 2012-2025

Completing the PA Annual Physical Examination Form online is a straightforward process designed to gather vital health information. This guide provides detailed instructions to help you navigate each section of the form efficiently.

Follow the steps to complete the form effectively.

1. Click ‘Get Form’ button to obtain the form and open it in the editor.
2. Begin with Part One, which is to be filled out before your medical appointment. Enter your full name, current address, date of your exam, social security number, date of birth, and the name of any person accompanying you. Indicate your sex by selecting either 'Male' or 'Female'.
3. In the 'Diagnoses/Significant Health Conditions' section, provide information about any chronic health problems or medical history summaries that are relevant.
4. List any current medications you are taking, including the medication name, dosage, frequency, diagnosis, prescribing physician, and their specialty. If necessary, attach a second page for additional medications.
5. Indicate if you take medications independently by checking 'Yes' or 'No'. Include any known allergies or sensitivities and contraindicated medications.
6. Complete the immunization records, noting the dates for Tetanus/Diphtheria, Hepatitis B, Influenza, and Pneumovax. Provide information on any other immunizations administered.
7. Complete the tuberculosis (TB) screening details, including the dates given and read, along with the results. Confirm if you are free of communicable diseases.
8. For additional medical tests, fill out the relevant sections regarding any tests such as GYN exams, mammograms, or prostate exams. Include dates and results accordingly.
9. Proceed to Part Two, the general physical examination section. Enter your blood pressure, pulse, respirations, temperature, height, and weight.
10. Evaluate systems by specifying if the findings are normal for each body system listed. Provide additional comments if needed.
11. If any further evaluation by a specialist is recommended, please indicate this in the corresponding section. Review your medical history summary and note any medication changes.
12. Document any health maintenance recommendations and dietary instructions in the provided fields.
13. Finally, complete the physician's information section, including their name, signature, address, and phone number.
14. Once you have filled out all sections, review your entries for accuracy. You can then save changes, download, print, or share the completed form as needed.

Start filling out the PA Annual Physical Examination Form online today for a seamless experience.